I, _________ Son/Daughter of _________  resident of _________, Authorized Signatory/Proprietor/Partner/Director of M/s. _________  situated at _________  do hereby solemnly declare as under:-

1.    That I have applied for the renewal of license/grant of registration under Adhoc registration scheme _________  for running the trade/unit of _________ of _________.

2.    That I had started the trade / unit above promises w.e.f. __________________.

3.    That the said trade/ unit is not pollutant/noxious/ hazards/inflammable.

4.    That I have submitted the following documents as proof of running the above said shop/trade/commercial unit:-

1)    Undertaking Affidavit
2)     NOC From Owner
3)     Lease deed/ Rent Agreement etc.
4)     Memorandum, Articles of Association
5)     Resolution (Authorized Signatory)
6)    Registration charges /Conversion Charges receipt.
7)     Site Plan & Key Plan etc.

5.    That I am in occupation of the said premises as owner/tenant w.e.f. ____________.

6.    That I have/do not have an electric connection in my name.

7.    That the _________ shall be empowered to revoke my registration/license, if any unauthorized construction is noticed in the aforesaid premises. The _________ authorities shall be competent to demolish the unauthorized construction and I shall not claim any compensation on that account.

8.    That I/we will not claim any alternative site in any confirming area in lieu of the of the ad hoc registration/ license  granted to me/us for the above said trade/unit run by me us in the non-confirming area details whereof have been mentioned here in above.

9.    That nothing has been concealed in this connection and I/we shall be responsible for all the consequences in case the above contents are found incorrect and registration may be cancelled at my/ our own risk.

10.    That I shall not claim regularization construction in respect of the premises in which the above said trade/ commercial activity in being run by me/ us on the basis of such ad hoc license/ registration.

11.    That I have neither changed the trade/commercial activity for which the ad hoc license was issued to me/ us in the year _________ nor have I/we added any new trade/ commercial unit after the grant of ad hoc license/ registration.

VERIFICATION:-

Verified at _________ on this _________ Month, _________ (Year) that contents of the above affidavit are true and correct to the best of my knowledge and belief and nothing is false or has been concealed there from.